We at Keystone Research Center and the We the People - Pennsylvania campaign know that a major challenge for Pennsylvania and for the nation is to enact policies that make the economy less rigged against working families.

In a move in line with Trump’s typical bait-and-switch — purporting to be a defender of the American working class but then doing everything he can to shift power and wealth upwards — he and his Justice Department have decided not to defend the Affordable Care Act’s (ACA) protection for those with pre-existing conditions. The pre-existing conditions provision is arguably the most popular piece of the ACA which ensures that insurance companies cannot deny, limit or overcharge anyone who has a pre-existing condition.

We at PBPC are engaged in a major effort to push back against legislation in the PA General Assembly to create work requirements for Medicaid and SNAP. The new federal Farm Bill put forward by House Republicans, which authorizes the SNAP (Food Stamp) program, has similar provisions.

As we have pointed out previously, because it repeals the individual mandate, the Senate tax cut proposal will not only lead to 13 million fewer people having health insurance in the United States, but it will lead to much higher premiums for many who do purchase health insurance on the individual market. The CBO’s estimate was that premiums nationwide would increase by 10%.

Marc Stier, Director of the PA Budget and Policy Center, made the following statement in response to President Trump's recent announcements of actions that affect the Affordable Care Act:

"President Trump’s actions in the last two days put the health insurance of over 400,000 Pennsylvanians at risk. It will lead to an increase in health insurance premiums in the marketplaces of over 20%.

As I write this, it is possible that the Graham-Cassidy bill to repeal the Affordable Care Act and make major changes to the traditional Medicaid program is already dying or dead. Two Republican members of the Senate, McCain of Arizona and Paul of Kentucky, have said they will vote against it. Senator Collins of Maine has announced that she is leaning against it. I’m hopeful that Senator Murkowski of Alaska will all announce that she is against it.

As I write this, the Senate is moving in a somewhat haphazard way to a vote on what has been called a “skinny” repeal of the Affordable Care Act. Not only do we not know exactly what will be included in the skinny repeal, but we, like members of the Senate, are uncertain about the point of passing such a bill.

Skinny Repeal as Trojan Horse

Most observers of the Senate believe that the goal of enacting a skinny repeal bill is simply to keep the process of repealing, or repealing or replacing, the Affordable Care Act alive. If the Senate acts on some health care bill that is an amendment of the AHCA passed by the House, the next step will be a House-Senate Conference Committee, which would write a final bill that attempts to thread the very narrow needle between more moderate and more conservative Republicans in both the House and Senate. The bulk of the work of the committee would, likely, be carried out in private among Republicans only. The bill it produces would go back to the House and Senate where it would receive an up and down vote with no opportunity for amendments.

Mitch McConnell and his Republican allies have one more trick up their sleeves to try to get some health care bill through the Senate. This week they will seek a vote to proceed to debate on the bill passed in the House on the understanding that there will be a process, colloquially known as voterama, in which a series of votes on one or more substitutes to the bill, or amendments, will be introduced. That is, Senators are being asked to proceed to debate without any clear idea what final bill they will eventually vote on.

I will say more about the process in a moment. But first I want to urge you to join the Insure PA / Protect Our Care phone bank to ask people in those states with Senators who are unsure about their position to call those Senators and ask them to vote no. (You can call Senator Toomey, too, but he pretty clearly has decided he cares far more about tax cuts for the rich than health care for Pennsylvanians.)

Earlier this week we released a blog post and a long paper called, “It Can’t Be Fixed” that explained why the basic structure of all of the Republican “repeal and replace” necessarily leads to a health care system in which large numbers of Americans and Pennsylvanians lose insurance.

The Congressional Budget Office (CBO) evaluation of the last version of the Senates’ Better Care Reconciliation Act (without the Cruz Amendment) released on Thursday confirms our argument once again. The CBO predicts that 22 million people will lose health insurance in the first decade. Our quick analysis of the impact on Pennsylvania shows that over one million will lose insurance in our commonwealth.